Regurgitation Is Less Responsive to Acid Suppression Than Heartburn in Patients With Gastroesophageal Reflux Disease

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• 作者：Peter J. Kahrilas^鈦?/sup> ; ^{p-kahrilas@northwestern.edu} ; Andreas Jonsson^&Dagger ; ; Hans Denison^&Dagger ; ; Bö ; rje Wernersson^&Dagger ; ; Nesta Hughes^§ ; ; Colin W. Howden^鈦?/sup>
• 关键词：PPI ; Esophagus ; Pain ; Stomach ; Drug
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：2012
• 期刊代码：pca92_15423565
• 类别：med
• 出版时间：June, 2012
• 卷：10
• 期：6
• 页码：612-619
• 文件大小：1874 K

摘要

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Background & Aims

Although most patients with gastroesophageal reflux disease (GERD) achieve substantial symptom relief with acid suppression, many have some residual symptoms. We evaluated the responsiveness of regurgitation, characterized by the reflux disease questionnaire (RDQ) to potent acid suppression.

Methods

We analyzed data from 2 randomized controlled trials of AZD0865 (a potassium-competitive acid blocker) 25-75 mg/day vs esomeprazole 20-40 mg/day for the treatment of nonerosive reflux disease (NERD, n = 1460) or reflux esophagitis (RE, n = 1514). Inclusion criteria for both studies were high-severity substernal burning (鈮? days per week of at least moderate intensity) during the week before enrollment. Pooled data from all treatment arms were used to ascertain the response of the reflux disease questionnaire regurgitation items to potent acid suppression during the fourth week of treatment.

Results

When the study began, 93%of patients with NERD or RE had either 鈥渁cid taste in the mouth鈥?(regurgitation-taste) or 鈥渦npleasant movement of material upwards from the stomach鈥?(regurgitation-movement). Either or both symptoms were present and severe in 53%of NERD (n = 717) and 54%of RE patients (n = 751) for the main study outcome. During week 4 of therapy, patients with severe 鈥渞egurgitation-taste鈥?and 鈥渞egurgitation-movement鈥?responded significantly less well than patients with NERD and high severity 鈥渟ubsternal burning鈥?(34%and 26%vs 49%) or those with RE (44%and 33%vs 55%). There were no differences in symptom response between patients with healed and nonhealed RE.

Conclusions

Regurgitation was less responsive to acid suppression than heartburn in patients with gastroesophageal reflux disease, indicating that persistent regurgitation is a common cause of incomplete treatment response.